MEDICARE: DR. RUSSELL P MAYER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3435	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043286891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL P MAYER D.D.S.

Provider Business Mailing Address
First Line	:	187 PINE CREST DR
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-8227
Country	:	US
Telephone Number	:	985-345-2285
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 W THOMAS ST
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-3038
Country	:	US
Telephone Number	:	985-345-2285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/08/2007

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